Down in the Mouth? An Oral Medicine Evaluation May Help

If you are being treated for cancer, have an autoimmune disease or an inflammatory condition that is causing an oral problem, you may benefit from an evaluation and treatment by an oral medicine specialist.

“Many conditions can cause mouth problems that affect quality of life. Sometimes patients cannot eat or speak due to sores in their mouth, pain, burning or mouth dryness,” says Alessandro Villa, DDS, MPH, Ph.D., chief of Oral Medicine, Oral Oncology and Dentistry at Baptist Health Miami Cancer Institute. “In addition, oral toxicities and complications can come along with cancer treatment. But there are many things we can do to lessen and eliminate these side effects.”

Alessandro Villa, DDS, MPH, Ph.D., chief of Oral Medicine, Oral Oncology and Dentistry at Baptist Health Miami Cancer Institute

Dr. Villa is the only cancer center-based board-certified oral medicine specialist in South Florida. He sees patients with problems of the lips, roof of the mouth, tongue, salivary glands and the inner lining of the cheeks ― whether or not they have cancer. Some of the conditions he treats are oral lichen planus, aphthous ulcers, dry mouth, jaw osteonecrosis, burning mouth syndrome, temporomandibular disorders and oral infections.

April is Oral Cancer Awareness Month. More than 58,000 new cases of oral and oropharyngeal cancer will be diagnosed this year in the U.S., according to American Cancer Society estimates. Autoimmune diseases, including lupus, rheumatoid arthritis, Type 1 diabetes, celiac disease and psoriasis are also on the rise, with conservative estimates stating that 23.5 million Americans are affected.

“Anyone with a sore, bump or colored lesion in the mouth that doesn’t go away, a dry or painful mouth or a canker sore that doesn’t heal should see a specialist,” says Dr. Villa, who before joining the Institute was chief of oral medicine at the University of California San Francisco Medical Center and an associate clinical professor of oral medicine and otolaryngology. His training included a residency in oral medicine at Harvard School of Dental Medicine/Brigham and Women’s Hospital, and a post-doctoral fellowship at the National Cancer Institute.

It’s particularly important for cancer patients who are scheduled for bone marrow transplants or head and neck radiation to undergo a dental evaluation before they begin treatment, Dr. Villa adds. A tooth or other mouth problem that occurs during or after treatment can lead to severe complications. These evaluations can typically be done by a dentist, and Dr. Villa has developed a dental education packet for patients to bring to their dentists to obtain any X-rays or clearance necessary prior to starting treatment for head and neck cancers.

Oral complications occur in approximately 40 percent of patients who receive chemotherapy, 80 percent of patients who undergo a stem cell transplant and 90 percent of those who receive radiation for head and neck malignancies, Dr. Villa says.

While smoking and tobacco use are considered major risks for oral and oropharyngeal cancer, the human papillomavirus (HPV) is responsible for the majority of oropharyngeal cases today. Fortunately, a vaccine that prevents many strains of HPV is available, and if you or your children (typically age 9-12 and up to 45 years) have not been vaccinated, speak to your primary care doctor or pediatrician about receiving the vaccine.

Some of Dr. Villa’s patients find relief using new medications that are available. He also performs procedures that include the biopsy of oral lesions, intralesional steroid injections, nonsurgical sequestrectomy (of the jawbone), topical and systemic medical treatments and trigger point injections.

Dr. Villa is also conducting research, heading and participating in clinical trials that include photobiomodulation for oral mucositis, a gene therapy study for dry mouth from radiation therapy for head and neck cancers and a new topical solution for burning mouth syndrome and oral dysesthesia.